Tuesday, March 8, 2016

Medicaid Coverage of Methadone Maintenance Linked to Use of Medication Assisted Treatment

Medicaid enrollees with opioid use disorders in states that cover methadone maintenance may be more likely to receive opioid agonist therapy (OAT) than those in states that do not cover this benefit, according to a report appearing in Psychiatric Services in Advance. The authors suggest the findings support Medicaid methadone maintenance coverage as critical for encouraging OAT among individuals with opioid use disorders.

Health services researchers from the Department of Health Policy and Management at Johns Hopkins University Bloomberg School of Public Health obtained information on states’ methadone maintenance coverage from a 2013 mail survey of Medicaid programs in all 50 states and the District of Columbia. The survey was conducted on behalf of the American Society of Addiction Medicine, which categorizes states into three mutually exclusive groups: states paying for methadone maintenance in the Medicaid fee-for-service benefit, states covering it only through Substance Abuse Prevention and Treatment (SAPT) block grants, and states with no public coverage of methadone maintenance. (States where methadone maintenance was covered through both Medicaid and SAPT were not separately identified.)

The researchers linked these state-level measures to the 2012 Treatment Episode Data Set, a database that annually includes information on 1.7 million public-sector substance abuse treatment admissions. They restricted the sample to Medicaid enrollees admitted to treatment for opioid use disorders (heroin or opioid analgesics), focusing on differences in use of OAT across three treatment settings: residential, intensive outpatient (three or more days per week, each with sessions of two or more hours), and non-intensive outpatient.

Overall, 7.0% of Medicaid enrollees in treatment for opioid use received OAT in states with no methadone coverage, whereas 46.6% received OAT in states with a Medicaid benefit that covers methadone maintenance, and 26.3% received OAT in states funding methadone only through a SAPT block grant. Non-intensive outpatient was the most common treatment setting.

In comments to Psychiatric News, John Renner, M.D. (pictured above), vice chair of the APA Council on Addiction Psychiatry, said the findings have important implications for addressing the nation’s opioid abuse epidemic. “The findings demonstrate that the most effective way to expand the availability of evidence-based medication assisted treatment (MAT) for individuals with opioid use disorder is to expand Medicaid coverage and to include MAT as a covered benefit,” Renner told Psychiatric News.

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